. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. is considered ad-visable to examine ocularly the condition of the portio vaginalisand OS uteri, and thus of obtaining evidence as to the presenceand nature of ulcerations, abrasions, excoriations, &c., of the partsin question. It is employed in cases in which it is considered ad-visable to explore the interior of the uterus itself, to facilitate, insome cases, the use of the uterine sound, and it is essential in theperformance of some operations involving the cervix or os uteri. Metliod of using
. The diagnosis, pathology and treatment of diseases of women including the diagnosis of pregnancy. is considered ad-visable to examine ocularly the condition of the portio vaginalisand OS uteri, and thus of obtaining evidence as to the presenceand nature of ulcerations, abrasions, excoriations, &c., of the partsin question. It is employed in cases in which it is considered ad-visable to explore the interior of the uterus itself, to facilitate, insome cases, the use of the uterine sound, and it is essential in theperformance of some operations involving the cervix or os uteri. Metliod of using the Speculuyn.—The mechanical contrivancesfor getting a view of the os uteri are very numerous. Simpletubes, tubes slit up into two or three segments, and lastly, theduckbill univalve instrument,—now known as Marion Simss,—have been successively employed. It is needless to describe thesevarious instruments in detail. The two instruments which are, in my opinion, best adaptedfor the purpose are a short bivalve instrument (a modification ofCuscos speculum), and Simss speculum. Fig. Cuscos speculum I have used for some time, and in the Ob-stetrical Societys catalogue, recently published, will be found adescription of one which I had constructed on this model, but alittle larger at the mouth, and more portable. Messrs. Weiss havesince improved the method of separating the blades, and it is nowa very complete instrument (Figs. 25 and 27). It has the advan- 240 DIAGNOSIS. tage of bringing the os uteri near to the ostium vaginae, a mostimportant point, and the aperture or mouth being hirge (1| in. byIf in.) great facilities for operations are offered. Its length isonly four inches. It is kept in place by its own action and re-quires no assistant. In using this instrument, the patient should be placed on theside with the knees drawn up, and the hips, a little higher thanthe thorax, should be quite at the edge of the examining speculum, previously oiled and warmed,
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